An eating disorder marked by weight loss, emaciation, a disturbance in body image, and a fear of weight gain that results in self-imposed starvation. Patients with the disorder lose weight either by excessive dieting, compulsive exercising, self-induced vomiting, or laxative or diuretic abuse to purge themselves of calories they have ingested. The illness is typically found in industrialized nations and usually begins in the teenaged years. Young women are 10 to 20 times more likely than men to suffer from the disorder. Weight loss of greater than 15% of body weight is typical, often with significant metabolic consequences. These may include severe electrolyte disturbances, hypoproteinemia with associated edema, and endocrine dysfunction. Immune disturbances, anemia, and secondary cardiac arrhythmias may occur. In women, amenorrhea is also characteristically accompanied by infertility and loss of libido. Repeated vomiting can cause esophageal erosion, ulceration, tears, and bleeding, as well as dental caries and tooth and gum erosion. The disease often resists therapy.
Diagnosis is made by the following criteria: Intense fear of becoming obese. This does not diminish as weight loss progresses. The patient claims to feel fat even when emaciated. A loss of 25% of original weight may occur. No known physical illness accounts for the weight loss. There is a refusal to maintain body weight over a minimal normal weight for age and height.

Psychiatric therapy in a hospital is usually required if the patient refuses to eat. The patient may need to be fed parenterally.
See: bulimiaNursing Diagnoses Appendix

PATIENT CARE
The nurse, nutritionist, and physician monitor the patient's vital signs and electrolyte balance; daily fluid intake and output; food types, amounts, and approximate nutrient intake; and laboratory values. The patient is weighed daily or weekly as prescribed. As necessary, the patient's body orifices, underarm area, and hair are checked for hidden weight before weighing. Small, frequent meals and nutritionally complete fluids are provided; the patient may accept the latter more readily. If tube feeding or parenteral nutrition is required, the procedure is explained to the patient and family. Edema or bloating, if present, is also explained, and the patient is reassured of its temporary nature. The patient's activities are strictly monitored as a precaution against vomiting, catharsis, or excessive exercise. The patient is taught that improved nutrition can correct abnormal laboratory findings. Arguments about food or related subjects are avoided. The patient is encouraged to recognize and express feelings; assertive behavior is supported. Assistance is offered to the family and close friends in dealing with their feelings about the patient and the patient's behavior, and they are instructed not to discuss food or weight with the patient. Individual, group, and family psychotherapy or behavior modification therapy are employed. The patient and family are encouraged to continue professional counseling on an outpatient basis, and are referred to local and national support and information organizations such as the Anorexia Nervosa and Related Eating Disorders Organization. Stable weight and eating patterns, the ability to express feelings, and the establishment of healthier patient-family relationships are indicators of successful intervention.

Main entry:
anorexia